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Why the Diagnosis of Attention Deficit Hyperactivity Disorder Matters % in to % in , to % in , and to 11% in (5, 6). Parents' own life course may also play a role in their perception of ADHD as a . ADHD patients and controls: to date the use of the radiological imaging has. Sat 3 Nov EDT First published on Sat 3 Nov EDT They also leave out a lot of life and try to make us not worry about it. . two questing, comically inept young sexual masochists off on their first "date". . of his story - this being well before we get into matters of goodness or likeability. A dramatic and lighter look at breast cancer told from a single woman's point of view. It's the true story of Linda Dackman (Ricki Lake), following her as she tries.

Novels can be sudden, pleasurably manipulative and blatant about their nature as artifice. They're generally just longer. They're a different sort of performance - but similar to the short story in their function and devices. Each is linear and made of words, each aims to please and aspires to beauty. Each enacts a kind of narrative and wants to make the reader pay closer attention to life before returning him to it renewed and better aware of what the writer deems important.

Novels can be and often are daring. They just have more "assets". If they try for more, risk more and they usually dothey also come equipped with more: In this way they're a more various and self-forgiving form.

A novel with a defective structure, a wrong opening movement, a dead end, or a fractured end part can still be a novel and may - on balance - be good think of Tender is the Night, The Sound and the Fury, The Sheltering Sky. But if a short story suffers these aesthetic flaws, it risks being nothing at all.

A minor aesthetic nullity. With the short story having so many of these formal features in common with its larger relative, what distinguishes it, what confers its basic self and what's so good about it seems to be linked to its brevity and to its bravura quality, its daring and again its audacity, to how it makes much of little, and to how it wields its authority as - to borrow from Auden - a "verbal artefact", lacking for the most part the supportive, fulfilling and camouflaging furnishment of a novel.

Historically, young writers who come to publishers carrying books of stories are either subjected to stern treatment or taken on with the bullying insistence that a novel's to come. The same Eudora Welty who wrote that "all serious daring starts from within" was made to prove that claim early in her writing life when New York publishers in the s declined her first virtuoso collection The Wide Net because she wouldn't knuckle down to writing a novel.

She just didn't want to. Nearly five decades later, when I myself was lurking around Esquire magazine - this was the middle s - and publishing an occasional short story, the editor-in-chief-of-the-moment told me over dinner one night that he wouldn't publish short stories at all in Esquire publisher of Hemingway, Fitzgerald, Capote, Flannery O'Connor, Carver, Bellow, Roth, Updike, Salter, Beattie if he could find something else to wedge in between the ads.

What it is that short stories uniquely do in the exercise of their audacious authority seems worth considering, especially since most art - sculpture, painting, music, even dance - can be viewed as being, at least in part, about the exercise of authority.

The sculptor takes a shapeless gob of clay or an apparently pointless hunk of I-beam and gets busy exerting on it. The painter squeezes the paint tube, lays on the colour, etc, etc.

The writer, for her part, exerts herself on otherwise unorganised language, creates utterances that provisionally subordinate our concerns to hers and - as we're induced to read on - draws us away from what we think toward what she thinks. And once we've, so to speak, surrendered in this way a giving-in to authority which in itself can be thrilling, pleasurable, cathartic and moreshe tries in all the strenuous, guileful and felicitous ways fiction can act upon us to authorise our response to every single thing she makes happen.

James's "geometry of his own" is the restrictive, importance-making exercise of in the case of writing fiction the writer's authority - as expressed by such authorial decisions as how much of this character to reveal, when to end a scene, where to commence the story and where to stop it.

When John Cheever's narrator, at the astonishing conclusion of his brief but harrowing story "Reunion" - published in the New Yorker in - bluntly tells us, "And that was the last time I saw my father We have known Cheever's two people - a father and son - for only a page or two and not well, we think. Can it really be, though, that the son never sees his father again - ever?

We would surely wonder about this in real life and demand to know more - require a novel to explain it all. But the story doesn't entertain doubt and neither do we. Relations in life may, indeed, stop nowhere. But in the hot alembic of the story's manufacture they do. Cheever's story is a model of short-story virtue, focus and conciseness. In fewer than a thousand words we visit Grand Central station twice, enter and depart three distinct midtown eateries.

Cocktails are consumed, harsh, assaultive even hilarious words are exchanged, tempers burn hot, dismay turns toxic. A callow son's hopes for resuscitating the love of his father are summarily ruined, following which a vital part of life is over for ever. Only, life's not like that - we say again. At least ours isn't - we hope. Yet within Cheever's great authority something of life we couldn't know any other way and that can't be truly paraphrased is shaped into indisputable truth for which the story is the only testament and evidence.

Moreover, this ferocity and concentration of the story's formal resources its formal brevity, dramatic emphasis, word choice, sudden closure are aesthetic features we readers like being close to, and submit to with pleasure - if only because these events aren't really happening to us.

And while saying this much may not tell us precisely why "Reunion" is so dazzling, it begins to suggest importantly how. And our awareness of this how may please us, too.

Nothing, in fact, may tell us definitively why any story is excellent. Cheever's story is about a father and a son in an instant of defining, galvanising crisis - the dramatic and moral values are thus set up high always a help. The scene and settings are recognisable, vivid and deftly limned. It's extremely funny, albeit in a hateful sort of way.

A risibly mean and pathetic drunk is given his to us satisfying comeuppance, while a sweet-seeming, impressionable son survives to tell the tale.

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Bliss is once again moved revealingly into the orbit of bale, all of it delivered inside a streamlined little verbal torpedo that explodes upon us almost before we know it.

That's, of course, not exactly it. What's it is the story's interconnected, amalgamated, shapely and irreducible self - embodying, representing, acquainting and connecting us to something crucial about life that doesn't even exist as intelligence or didn't except in these specific terms and by no other authority than this. Cheever was a great writer - full stop, as the English so enjoy saying. And his story, with all its foreshortenings, daring spatial and temporal improbabilities, drastic economies and subordinations cannot finally be assayed, but simply is "Real-life improbability rendered fictively plausible by authorial main force inside a small space of words" may be one provisional, exploded description of a good short story and part of the source of its pleasing torque.

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We like experiencing the implausible made plausible; how else to explain the American presidency? Mary Gaitskill's nervy, roguish story, "A Romantic Weekend", sets two questing, comically inept young sexual masochists off on their first "date". Things get started wrong for the "lovers", get wrong-er, get very wrong and funnyget messy, painful, get hopeless, then strangely and quickly transmute, on the strength of Gaitskill's imagination, into something like amity and empathy, before a lost weekend's nearly rescued and the characters go safely home.

Balanced on great timing, wit, intelligence, humanity and conciseness, "A Romantic Weekend" pivots on Gaitskill's ability - in the galvanising force-field of art fastened to an apt form - to draw strength from improbability and brevity, and from the author's will to transform both into something probable and indeed into something close to love's first pulse beats.

I'm not attempting to pronounce a formula here: Nothing improbable happens, however, in Chekhov's elegant "The Lady with the Dog", the all-time short-story gold standard, in which a rather dull married man encounters a rather aimless married woman in a Crimean seaside resort consecrated for exactly these casually furtive rendezvous.

The two commence a tepid affair, then dutifully trudge home to separate cities and lives, only to be drawn again to each other's tenderness for reasons that seem eminently ordinary they're bored, they're willing, and they're ablefollowing which re-coupling, a complex and predictably desultory future is quietly acknowledged and acceded to.

And there the story, in what seems both an undramatic but also oddly pressurised fashion, ends. There's no flashy audacity here - unless you care to say and, of course, I do that Chekhov's act of magisterial authority is in choosing and then forcing these rather sallow, nearly featureless beings and prosaic behaviours on to our notice as formal constituents and moral integers of a short story.

The story - and it's as good as any of us will ever read - is full of fine, nuanced, writerly precisions, skewering verbal and dramatic ironies, great if concisely set emphases, and the pathos of human frailty half-enlivened by sex.

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But the first great authoritative leap is in the imagining - in Chekhov's daring to imagine what a great story could conceivably perhaps improbably be about. Once you begin to think that writing fiction is all about writers exerting authority upon readers, pretty soon the evidence starts to pop up everywhere. Writers exercising authority is, of course, not the thing fiction is all about, nor the key to what makes short stories great.

Great stories are congeries of plan, vigour, will and application, but also of luck and error and intuition and even, God knows, sudden inspiration for all of which there is no key, and in the midst of which things often just happen - a fact that should make us like stories even better for their life-mimicking knack of seeming to come out of nowhere, thereby fortifying our faith in art and life's mystery.

To perform these great mimetic feats by which art and life have similar effects, short stories and novels, too almost always contain small and large, glaringly obvious and also barely observable exertions of their writers' authority.

By authority I mean, roughly speaking, a writer's determination, variously enacted, to assume provisional command of a reader's attention and volition, thereby overcoming the reader's resistance and engaging his credulity for the purpose of interposing some scheme the writer imagines to be worth both his and the reader's time and trouble. This is the privileged tap on the would-be reader's shoulder that many young writers take as their due, but that many older writers grow to feel - by dint of time spent reading - is an act of imposition whose harsh demands ought to be weighed in strict moral terms and ultimately rewarded.

This first conceptual act of authority "I've dreamed up a story - for somebody" pretty quickly, however, materialises into the actual story itself and its first significant gesture, excluding the title.

I myself once began a story with what I believed to be the brash and irresistible sentence - because I thought brash was good - "This is not a happy story, I warn you.

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Certainly there's no black-letter law for how to overcome the reader's preoccupations elsewhere, and thus to allow the writer his specific authoritative intentions. Which is fine if you want to do that and are willing to sacrifice any other plans you might have. But what if you, like Wolff, have something else in mind that doesn't involve men with guns and that still seems important? Something has to persuade us readers that we're being confronted with a force a mind, a promising competence, a storage of words, an appealing imagination that has something for us that we need, will be better for and possibly renewed by.

This initial gesture implying the good promise of the story's waiting self, represents one aspect and one bit of evidence of a story's authority.

Wolff's deft, understated, almost mannerly first sentence lets us know imposing things: It's daring, but it's daring that comes from within. Not that everything has to take place with the very first scratch on the page - as happens, say, in Denis Johnson's story "Work", which begins: Parenting knowledge, attitudes, and practices are shaped not only by each other but also by a number of contextual factors, including children's characteristics e.

Of particular relevance to this study, the contextual factors that influence parenting knowledge, attitudes, and practices also include the supports available within the larger community and provided by institutions, as well as by policies that affect the nature and availability of supportive services.

In response to the study charge Box in Chapter 1this chapter presents the evidence on core parenting knowledge, attitudes, and practices separately. However, it should be noted that in the research literature, the distinctions among these concepts, especially knowledge and attitudes, are not well-delineated and that the applications of these concepts to parenting often are equally informed by professional wisdom and historical observation. Parenting Knowledge Parenting is multidimensional.

To respond to the varied needs of their children, parents must develop both depth and breadth of knowledge, ranging from being aware of developmental milestones and norms that help in keeping children safe and healthy to understanding the role of professionals e. This section describes these areas of knowledge, as well as others, identified by the available empirical evidence as supporting core parenting practices and child outcomes.

It is worth noting that the research base regarding the association between parental knowledge and child outcomes is much smaller than that on parenting practices and child outcomes Winter et al. Where data exist, they are based largely on correlational rather than experimental studies. Knowledge of Child Development Parent Voices [Some parents recognized the need for education related to providing care for young children.

Just because I have a degree, it does not mean it is a degree on how to take care of a child. As they suggest, to optimize children's development, parents need a basic understanding of infant and child developmental milestones and norms and the types of parenting practices that promote children's achievement of these milestones Belcher et al.

A robust body of correlational research demonstrates tremendous variation in parents' knowledge about childrearing. Several of these studies suggest that parents with higher levels of education tend to know more about child developmental milestones and processes Bornstein et al.

This greater knowledge may reflect differential access to accurate information, differences in parents' trust in the information or information source, and parents' comfort with their own abilities, among other factors. For example, research shows that parents who do not teach math in the home tend to have less knowledge about elementary math, doubt their competence, or value math less than other skills Blevins-Knabe et al.

However, parents' knowledge and willingness to increase their knowledge may change; thus, they can acquire developmental knowledge that can help them employ effective parenting practices. Parent Voices [Some parents recognized the need for comprehensive parenting education. From pregnancy, some don't know when to go to the doctor, and after birth, when to go to the hospital or the doctor.

So we need education from the beginning to the end. For example, mothers who have a strong body of knowledge of child development have been found to interact with their children more positively compared with mothers with less knowledge Bornstein and Bradley, ; Huang et al. Parents who understand child development also are less likely to have age-inappropriate expectations for their child, which affects the use of appropriate discipline and the nature and quality of parent-child interactions Goodnow, ; Huang et al.

Support for the importance of parenting knowledge to parenting practices is found in multiple sources and is applicable to a range of cognitive and social-emotional behaviors and practices. Several correlational studies show that mothers with high knowledge of child development are more likely to provide books and learning materials tailored to children's interests and age and engage in more reading, talking, and storytelling relative to mothers with less knowledge Curenton and Justice, ; Gardner-Neblett et al.

Fathers' understanding of their young children's development in language and literacy is associated with being better prepared to support their children Cabrera et al. And parents who do not know that learning begins at birth are less likely to engage in practices that promote learning during infancy e.

For example, mothers who assume that very young children are not attentive have been found to be less likely to respond to their children's attempts to engage and interact with them Putnam et al. Stronger evidence of the role of knowledge of child development in supporting parenting outcomes comes from intervention research.

Randomized controlled trial interventions have found that parents of young children showed increases in knowledge about children's development and practices pertaining to early childhood care and feeding Alkon et al.

Some studies have found a direct association between parental knowledge and child outcomes, including reduced behavioral challenges and improvements on measures of cognitive and motor performance Benasich and Brooks-Gunn, ; Dichtelmiller et al.

In an analysis of data from a prospective cohort study that controlled for potential confounders, children of mothers with greater knowledge of child development at 12 months were less likely to have behavior problems and scored higher on child IQ tests at 36 months relative to children of mothers with less developmental knowledge Benasich and Brooks-Gunn, This and other observational studies also show that parental knowledge is associated with improved parenting and quality of the home environment, which, in turn, is associated with children's outcomes Benasich and Brooks-Gunn, ; Parks and Smeriglio, ; Winter et al.

Experimental studies of parent education interventions support these associational findings. In an experimental study of parent education for first-time fathers, fathers, along with home visitors, reviewed examples of parental sensitivity and responsiveness from videos of themselves playing with their children Magill-Evans et al.

These fathers showed a significant increase in parenting competence and skills in fostering their children's cognitive growth as well as sensitivity to infant cues 2 months after the program, compared with fathers in the control group, who discussed age-appropriate toys with the home visitor Magill-Evans et al.

Another experimental study examined a week population-level behavioral parenting program and found intervention effects on parenting knowledge for mothers and, among the highest-risk families, increased involvement in children's early learning and improved behavior management practices. Lower rates of conduct problems for boys at high risk of problem behavior also were found Dawson-McClure et al.

Knowledge of Parenting Practices Parents' knowledge of how to meet their children's basic physical e. Specifically, parenting knowledge about proper nutrition, safe sleep environments, how to sooth a crying baby, and how to show love and affection is critical for young children's optimal development Bowlby, ; Chung-Park, ; Regalado and Halfon, ; Zarnowiecki et al.

For many parents, for example, infant crying is a great challenge during the first months of life. Parents who cannot calm their crying babies suffer from sleep deprivation, have self-doubt, may stop breastfeeding earlier, and may experience more conflict and discord with their partners and children Boukydis and Lester, ; Karp, Correlational research indicates that improvement in parental knowledge about normal infant crying is associated with reductions in unnecessary medical emergency room visits for infants Barr et al.

That knowledge leads to changes in behavior is further supported in systematic reviews by Bryanton and colleagues of randomized controlled trials and Middlemiss and colleagues of studies with various design types, with both groups reporting that increases in mother's knowledge about infant behavior is associated with positive changes in the home environment, as well as improvements in infant sleep time. Specific knowledge about health and safety—including knowledge about how to access health care, protect children from physical harm e.

Experimental studies show, for example, a positive link between parents' knowledge of nutrition and both children's intake of nutritious foods and reduced calorie and sodium intake Campbell et al. In a randomized controlled trial, Campbell and colleagues found that children whose parents received knowledge, skills, and social support related to infant feeding, diet, physical activity, and television viewing consumed fewer sweet snacks and spent fewer minutes daily viewing television relative to children whose parents were in the control group Campbell et al.

Also associated with children's intake of nutritious foods is parents' modeling of good eating habits and nutritional practices Mazarello Paes et al.

In addition, although limited in scope, correlational evidence shows that parents with knowledge about immunization are more likely to understand its purpose and comply with the timetable for vaccinations Smailbegovic et al.

Other studies have found that parents with more information about the purpose of vaccinations had greater knowledge of immunization than parents in the control group Hofstetter et al. Still, knowledge alone may not be sufficient in some cases. For example, knowing about the importance of using car seats does not always translate into good car seat practices Yanchar et al.

Some findings suggest that using multiple modes of delivery is important to advancing parents' knowledge. In an experimental study, for example, Dunn and colleagues found that parents who received educational information about child vaccinations via videotape as well as in written form showed greater gains in understanding about vaccinations than parents who received the information in written form alone.

The evidence linking parental knowledge about the specific ways in which parents can help children develop cognitive and academic skills, including skills in math, is limited. However, the available correlational data show that parents who know about how children develop language are more likely to have children with emergent literacy skills e. Much of this work has focused on book reading and parent-child engagement around reading Hindman et al. As early as the s, Durkin and others referred to the important role of the home literacy environment and parents' beliefs about reading in children's early literacy development.

Knowledge of Supports, Services, and Systems Little is known about parents' knowledge of various supports—such as educators, social workers, health care providers, and extended family—and the relationship between their conceptions of the roles of these supports and their use of them. To take an example, parents' knowledge about child care and their school decision-making processes are informed in a variety of ways through these different supports. In their literature review of child care decision making, Forry and colleagues found that many low-income parents learn about their child care options through their social networks rather than through professionals or referral agencies.

While many parents say they highly value quality, their choices also may reflect a range of other factors that are valued. Parents tend to make child care decisions based on structural teacher education and training and process activities, parent-provider communication features, although their choices also vary by family income, education, and work schedules.

Sosinsky and Kimfor example, found that higher maternal education and income and being white were associated with the likelihood of parents choosing higher-quality child care programs that were associated with better child outcomes.

Based on a survey of parents of children in a large public school system, Goldring and Phillips found that parents' involvement, not satisfaction with their child's school, was associated with school decision making. It should be noted that while parents may know what constitutes high-quality child care and education, structural availability of quality programs and schoolsindividual work, income, beliefand child temperament, age factors also influence these decision-making processes Meyers and Jordan, ; Shlay, Taking another example, limited studies have looked at parental awareness of services for children with special needs.

A study that utilized a survey and qualitative interviews with parents of children with autism indicated that parents' autism spectrum disorder service knowledge partially mediates the relationship between socioeconomic status and use of services for their children Pickard and Ingersoll, Parenting Attitudes Although considerable discussion has focused on attitudes and beliefs broadly, less research attention has been paid to the effects of parenting attitudes on parents' interactions with young children or on parenting practices.

Few causal analyses are available to test whether parenting attitudes actually affect parenting practices, positive parent-child interaction, and child development. Even less research exists on fathers' attitudes about parenting. Given this limited evidence base, the committee drew primarily on correlational and qualitative studies in examining parenting attitudes. Parents' attitudes toward parenting are a product of their knowledge of parenting and the values and goals or expectations they have for their children's development, which in turn are informed by cultural, social, and societal images, as well as parents' experiences and their overall values and goals Cabrera et al.

People in the United States hold several universal, or near universal, beliefs about the types of parental behaviors that promote or impair child development.

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For example, there is general agreement that striking a child in a manner that can cause severe injury, engaging in sexual activity with a child, and failing to provide adequate food for and supervision of young children such as leaving toddlers unattended pose threats to children's health and safety and are unacceptable.

At the same time, some studies identify differences in parents' goals for child development, which may influence attitudes regarding the roles of parents and have implications for efforts to promote particular parenting practices.

While there is variability within demographic groups in parenting attitudes and practices, some research shows differences in attitudes and practices among subpopulations.

For example, qualitative research provides some evidence of variation by culture in parents' goals for their children's socialization. In one interview study, mothers who were first-generation immigrants to the United States from Central America emphasized long-term socialization goals related to proper demeanor for their children, while European American mothers emphasized self-maximization Leyendecker et al.

In another interview study, Anglo American mothers stressed the importance of their young children developing a balance between autonomy and relatedness, whereas Puerto Rican mothers focused on appropriate levels of relatedness, including courtesy and respectful attentiveness Harwood et al. Other ethnographic and qualitative research shows that parents from different cultural groups select cultural values and norms from their country of origin as well as from their host country, and that their goal is for their children to adapt and succeed in the United States Rogoff, Similarly, whereas the larger U.

The importance of intergenerational connections e. The values and traditions of cultural communities may be expressed as differences in parents' views regarding gender roles, in parents' goals for children, and in their attitudes related to childrearing. Parent Voices [One parent described differences between men and women in parenting roles.

Culturally men aren't that involved. The dad is the outer worker; the mother is the inner worker. If you are talking about the mom, they are the ones who care about the kids. They aren't typically working outside the home. But now, in the United States, the mothers are working outside the home.

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Research has shown that fathers of young children participate in child caregiving activities in increasing numbers Cabrera et al. Parents' values and goals related to childrearing, both overall and for specific demographic groups, also may shift from one generation to the next in the United States based on changing norms and viewpoints within social networks and cultural communities, as well as parents' knowledge of and access to new research and information provided by educators, health care providers, and others who work with families.

Relatively little research has been conducted on parents' attitudes toward specific parenting-related practices. Much of the extant research focuses on practices related to promoting children's physical health and safety. Studies of varying designs indicate that parental attitudes and beliefs about the need for and safety of vaccination influence vaccination practices Mergler et al.

Maternal attitudes and beliefs about breastfeeding e. Other studies have found differences among parents e. Parental involvement in children's education has been linked to academic readiness Fan and Chen, However, parents differ in their attitudes about the role of parents in children's learning and education Hammer et al.

Some see parents as having a central role, while others view the school as the primary facilitator of children's education and see parents as having less of a role Hammer et al. These attitudinal differences may be related to cultural expectations or parents' own education or comfort with teaching their children certain skills. Some parents, for example, may have lower involvement in their children's education because of insecurity about their own skills and past negative experiences in school Lareau, ; Lawrence-Lightfoot, And as discussed above, some parents view math skills as less important for their children relative to other types of skills and therefore are less likely to teach them in the home.

Parents within and across different communities vary in their opinions and practices with respect to the role and significance of discipline. Some of the parenting literature notes that some parents use control to discipline children, while others aim to correct but not to control children Nieman and Shea, In a small cross-cultural ethnographic study, Mosier and Rogoff found that some parents regard rules and punishment as inappropriate for infants and toddlers.

The approach valued by these parents to help children understand what is expected of them is to cooperate with them, perhaps distracting them but not forcing their compliance. In contrast, many middle-class U. And ethnographic research provides some evidence of differences in African American and European American mothers' beliefs about spoiling and infant intentionality whether infants can intentionally misbehave related to the use of physical punishment with young children Burchinal et al.

Parents' attitudes not only toward parenting but also toward providers in societal agencies—such as educators, social service personnel, health care providers, and police—which can be shaped by a variety of factors, including discrimination, are important determinants of parents' access to and ability to obtain support. Studies show a relationship between parents' distrust of agencies and their likelihood of rejecting participation in an intervention. For example, in systematic reviews of studies of various types, parents who distrust the medical community and government health agencies are less likely to have their children vaccinated Brown et al.

Racial and ethnic minority parents whose attitudes about appropriate remedies for young children vary from those of the Western medical establishment often distrust and avoid treatment by Western medical practitioners Hannan, While not specific to parents, studies using various methodologies show that individuals who have experienced racial and other forms of discrimination, both within and outside of health care settings, are less likely to utilize various health services or to engage in other health-promoting behaviors Gonzales et al.

In a survey study, African American parents' racism awareness was negatively associated with involvement in activities at their children's school McKay et al. Longitudinal studies, mostly involving families with older children, indicate that, like other sources of stress, parents' experience of discrimination can have a detrimental effect on parenting and the quality of the parent-child relationship Murray et al. As noted earlier, attitudes are shaped in part by parenting self-efficacy—a parent's perceived ability to influence the development of his or her child.

Parenting self-efficacy has been found to influence parenting competence including engagement in some parenting practices as well as child functioning Jones and Prinz, Studies show associations between maternal self-efficacy and children's self-regulation, social, and cognitive skills Murry and Brody, ; Swick and Hassell, Self-efficacy also may apply to parents' confidence in their capacity to carry out specific parenting practices.

For example, parents who reported a sense of efficacy in influencing their elementary school-age children's school outcomes were more likely to help their children with school activities at home Anderson and Minke, A multimethod study of African American families found that maternal self-efficacy was related to children's regulatory skills through its association with competence-promoting parenting practices, which included family routines, quality of mother-child interactions based on observer ratings, and teachers' reports of mothers' involvement with their children's schools Brody et al.

Henshaw and colleagues found in a longitudinal study that higher breastfeeding self-efficacy predicted exclusive breastfeeding at 6 months postpartum, as well as better emotional adjustment of mothers in the weeks after giving birth.

Parenting Practices Parenting practices have been studied extensively, with some research showing strong associations between certain practices and positive child outcomes. This section describes parenting practices that research indicates are central to helping children achieve basic outcomes in the areas discussed at the beginning of the chapter: While these outcomes are used as a partial organizing framework for this section, several specific practices—contingent responsiveness of parents, organization of the home environment and the importance of routines, and behavioral discipline practices—that have been found to influence child well-being in more than one of these four outcome areas are discussed separately.

Practices to Promote Physical Health and Safety Parents influence the health and safety of their children in many ways. However, the difficulty of using random assignment designs to examine parenting practices that promote children's health and safety has resulted in a largely observational literature.

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This section reviews the available evidence on a range of practices in which parents engage to ensure the health and safety of their children. It begins with breastfeeding—a subject about which there has historically been considerable discussion in light of generational shifts and commercial practices that have affected children in poor families.

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Breastfeeding Breastfeeding has myriad well-established short- and long-term benefits for both babies and mothers. Breast milk bolsters babies' immunity to infectious disease, regulates healthy bacteria in the intestines, and overall is the best source of nutrients to help babies grow and develop. Breastfeeding also supports bonding between mothers and their babies. Breastfeeding may benefit mothers' health as well by lowering risk for postpartum depression, certain cancers, and chronic diseases such as diabetes U.

Department of Health and Human Services, Current guidelines from the American Academy of Pediatrics and the WHO recommend mothers breastfeed exclusively until infants are 6 months old.

Thereafter and until the child is either age 1 year American Academy of Pediatrics, or 2 years World Health Organization,it is recommended that children continue to be breastfed while slowly being introduced to other foods. According to data from the CDC aabout 80 percent of babies born in the United States are breastfed including fed breast milk for some duration, and about 50 percent and 27 percent are breastfed to any extent with or without the addition of complementary liquids or solids at 6 and 12 months, respectively.

Forty percent and 19 percent are exclusively breastfed through 3 and 6 months, respectively. Mothers in the United States often cite a number of reasons for not initiating or continuing breastfeeding, including lack of knowledge about how to breastfeed, difficulty or pain during breastfeeding, embarrassment, perceived inconvenience, and return to work Hurley et al. Low-income women with less education are less likely than women of higher socioeconomic status to breastfeed Heck et al.

Some research with immigrant mothers shows that rates of breastfeeding decrease with each generation in the United States, possibly because of differences in acceptance of bottle feeding here as compared with other countries e.

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Nutrition and physical activity Parents play an important role in shaping their young children's nutrition and physical activity levels Institute of Medicine, ; Sussner et al. Among toddlers and preschool-age children, parents' feeding practices are associated with their children's ability to regulate food intake, which can affect weight status Faith et al.

Parents' modeling of healthful eating habits for their children and offering of healthful foods, particularly during toddlerhood, when children are often reluctant to try new foods, may result in children being more apt to like and eat such foods Hill, ; Natale et al. The extant observational research generally shows that children's dietary intake particularly fruit and vegetable consumption is associated with food options available in the home and at school, and that parents are important role models for their children's dietary behaviors Cullen et al.

Conversely, the presence of less nutritious food and beverage items in the home may increase children's risk of becoming overweight. For example, Dennison and colleagues and Welsh and colleagues found positive associations between overweight in children and their consumption of sugar-sweetened beverages. On the other hand, there are some indications that overly strict diets may increase children's preferences for high-fat, energy-dense foods, perhaps causing an imbalance in children's self-regulation of hunger and satiety and increasing the risk that they will become overweight Birch and Fisher, ; Farrow et al.

A few cross-sectional and longitudinal studies, coupled with conventional wisdom, suggest that eating dinner together as a family is associated with increased consumption of fruits, vegetables, and whole grains and reduced consumption of fats and soda Gillman et al. However, these studies involved primarily older children and adolescents. Physical activity is a complement to good nutrition. Even in young children, physical activity is essential for proper energy balance and prevention of childhood obesity Institute of Medicine, ; Kohl and Hobbs, It also supports normal physical growth.

Parents may encourage activity in young children through play e. Children who spend more time outdoors may be more active e. For many parents living in high-crime neighborhoods, however, most of whom are racial and ethnic minorities, the importance of safety overrides the significance of physical activity.

In some neighborhoods, safety issues and lack of access to parks and other places for safe recreation make it difficult for families to spend time outdoors, leading parents to keep their children at home Dias and Whitaker, ; Gable et al. Although more of the research on screen time and sedentary behavior has focused on adolescents than on young children, several cross-sectional and longitudinal studies on younger children show an association between television viewing and overweight and inactivity Ariza et al.

An analysis of data on 8, children participating in a longitudinal cohort study showed that those who watched more television during kindergarten and first grade were significantly more likely to be clinically overweight by the spring semester of third grade Gable et al.

Although television, computers, and other screen media often are used for educational purposes with young children, these findings suggest that balancing screen time with other activities may be one way parents can promote their children's overall health. As with diet, children's sedentary behavior can be influenced by parents' own behaviors. For example, De Lepeleere and colleagues found an association between parents' screen time and that of their children ages in a cross-sectional study.

Vaccination Parents protect their own and other children from potentially serious diseases by making sure they receive recommended vaccines.